{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jeffrey P Dalrymple","gend":0,"add":"456 Bald Eagle Path","city":"Cleveland","state":"GA","zip":30528,"dob":"1960-08-20","age":"","mstatus":"","insh":1374641001,"cliId":"","pno":4043176106,"cno":"","email":"jpdalrymple@gmail.com","ename":"","eno":"","pphy":"Sakib Maya","ppno":"","pcpadd":"4889 Golden Parkway Ste 100","pcpcity":"Buford","pcpstate":"GA","pcpzip":"","pcpcounty":"Buford","pcpid":"","pcpname":"","plan":"ALLIANT","program":"ACA","lob":"","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.9","H16.223","H16.213","H40.053","H25.13","H52.03","H52.223","H52.4","E11.329","E11.40","I10","R74.01","E11.69","E78.2","Z20.822","R10.9","R50.9","R43.2","R11.0","E83.118","E11.65","F33.0","F10.20","G62.9","Z87.891","Z79.4","Z68.34","F33.2","K70.9","E83.119","H54.7","H91.90","R26.89","R29.898","M62.81","Z20.828","E11.9","F32.9","Z79.899","Z11.59","D69.6","R74.0","R53.83","R10.13","F10.11","G56.03","K76.0","K74.01","Z00.00","Z23","Z12.5","Z12.11","D59.9","K21.9","I25.10","E83.110","M54.16","M41.25","E11.42","F41.8","Z68.33","H47.233","H53.453","F10.982","D12.3","K35.30","R10.30","E87.5","I25.84","K58.0","H53.53","H53.55","Z68.32","K35.80","R16.1","K80.20","K40.20","K35.890","R63.0","D89.0","R80.9","M48.061","M51.17","M47.27","F10.10","R74.8","Z86.010","K59.09","F10.239","J01.41","R05","H81.10","G60.9","M54.6","K59.00"],"date":["2021-12-16","2021-12-28","2021-12-28","2020-12-29","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-11-16","2021-11-09","2021-10-05","2021-11-09","2021-11-09","2021-03-09","2021-03-16","2021-03-09","2021-03-09","2021-03-09","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-11-09","2021-11-09","2020-06-23","2021-10-12","2020-06-23","2020-06-23","2021-12-07","2021-12-07","2021-12-07","2021-01-05","2021-07-20","2020-06-23","2021-05-25","2020-06-23","2021-10-19","2020-11-17","2021-11-09","2021-05-25","2021-05-25","2020-10-06","2021-09-07","2021-10-19","2021-07-20","2021-11-09","2021-07-20","2021-12-21","2021-07-20","2021-07-20","2021-11-09","2021-11-09","2021-11-18","2021-09-22","2021-12-28","2021-09-22","2021-03-23","2021-12-28","2021-12-28","2020-07-07","2021-10-12","2021-03-16","2021-03-16","2021-12-28","2021-11-09","2021-12-21","2021-12-15","2021-12-15","2020-09-15","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2020-07-07","2020-10-27","2020-10-27","2021-08-24","2021-08-24","2021-08-24","2020-06-16","2021-12-21","2021-12-21","2020-11-17","2020-06-16","2020-01-28","2020-01-28","2020-01-28","2021-12-28","2021-08-10","2021-03-09"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","64380071206","BENZONATATE","100MGCAPSULE","15","Select","Select",""],["","68382050010","OMEPRAZOLE","DR40MGCAPSULE","30","Select","Select",""],["","2143380","TRULICITY","0.75MG\/0.5MLPEN","2","Select","Select",""],["","68180029606","DULOXETINE","HCLDR60MGCAP","30","Select","Select",""],["","93720198","PRAVASTATIN","SODIUM20MGTAB","30","Select","Select",""],["","67877056305","METFORMIN","HCL1000MGTABLET","60","Select","Select",""],["","60505265301","TRAZODONE","50MGTABLET","30","Select","Select",""],["","69097094312","GABAPENTIN","300MGCAPSULE","150","Select","Select",""],["","8627001601","DEXCOM","G6TRANSMITTER","1","Select","Select",""],["","68180072103","AMLODIPINE","BESYLATE10MGTAB","30","Select","Select",""],["","70710122501","AMITRIPTYLINE","HCL10MGTAB","60","Select","Select",""],["","43547035611","LISINOPRIL","40MGTABLET","30","Select","Select",""],["","597015330","JARDIANCE","25MGTABLET","30","Select","Select",""],["","65862050320","AMOX-CLAV","875-125MGTABLET","20","Select","Select",""],["","68462015713","ONDANSETRON","ODT4MGTABLET","5","Select","Select",""],["","52268020101","SUTAB","1.479-0.225-0.188GMTAB","24","Select","Select",""],["","378047705","DIAZEPAM","10MGTABLET","2","Select","Select",""],["","54092060601","XIIDRA","0.05EYEDROPS","60","Select","Select",""],["","72205001590","PREGABALIN","150MGCAPSULE","60","Select","Select",""],["","59267100001","PFIZER","COVID-19VACCINE(EUA)","0.3","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}